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Front Microbiol. 2015 Jun 30;6:646. doi: 10.3389/fmicb.2015.00646. eCollection 2015.

Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly.

Author information

1
Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire de Tours, UMR 1282 Tours, France ; Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire de Tours France.
2
Service of Hospital Preventive Medicine, Lausanne University Hospital Lausanne, Switzerland.
3
Service d'Hygiéne Hospitaliére, Centre Hospitalier Universitaire de Besançon, UMR CNRS 6249, Chrono-environnement, Université Bourgogne Framche-Comté Besançon, France.
4
Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire de Tours, UMR 1282 Tours, France.

Abstract

We conducted a survey including 3334 bloodstream infections (BSIs) due to E. coli diagnosed in 2005-2014 at a stable cohort of hospitals. Marked increases in incidence were observed for community-acquired (CA) BSIs in patients aged >75 years, CA-BSIs of digestive origin in patients aged 60-74 years, healthcare-associated BSIs, and BSIs associated with ESBL (extended-spectrum B-lactamase)-producing E. coli (ESBLEc). Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the 2014 survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D. Among the 31 ESBLEc isolates, 1/3 belonged to STC 131. We searched for possible associations between clonal groups, clinical determinants and characteristics of BSIs: isolates from groups B2 (except STC 131) and D were susceptible to antibiotics and associated with BSIs of urinary origin in patients <60 years. STC 131 and group A/B1 isolates were multi-drug resistant and associated with CA-BSIs of digestive origin in patients aged 60-74 with a recent history of antibiotic treatment. STC 131 isolates were associated with HCA-BSIs in patients with recent/present hospitalization in a long-stay unit. We provide a unique population-based picture of the epidemiology of E. coli BSI. The aging nature of the population led to an increase in the number of cases caused by the B2 and D isolates generally implicated in BSIs. In addition, the association of a trend toward increasing rates of gut colonization with multi drug-resistant isolates revealed by the rise in the incidence of BSIs of digestive origin caused by STC 131 and A/B1 (STCs 10, 23, and 155) isolates, and a significant increase in the frequency of BSIs in elderly patients with recent antibiotic treatment suggested that antibiotic use may have contributed to the growing incidence of BSI.

KEYWORDS:

Escherichia coli; ST 131; antibiotic; bloodstream infection; elderly

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